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THEODORE DEITZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5580
(708) 684-4068
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.078500
IL
208000000X
Pediatrics Physician
125.078500
IL
2080P0202X
Pediatric Cardiology Physician
Primary
036.170936
IL

Other

Enumeration date
03/23/2021
Last updated
05/16/2025
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